August 14, 2016 marks a turning point for the history of health care in the province of Ontario. 63.1% of Ontario Medical Association (OMA) members rejected the Liberal government’s proposed Physician Services Agreement (PSA) and in so doing voiced their vehement disagreement with the trajectory of health care in Ontario.

This is not meant as a criticism of the PSA even though it is an agreement that is certainly worthy of our criticism. It is worth recognizing the many rational reasons physicians had for voting for the proposed agreement. The Liberal Government of Ontario’s rejected PSA was beyond disastrous. It was bad for the health care system and economically untenable. It intentionally underfunded health care at a rate lower than health care growth and would have necessitated longer wait lists, clinic closures, doctor relocations to other provinces and countries, and the delisting of medically necessary services. It also would have significantly cut individual physician salaries on a progressive basis over four years after accounting for inflation. With all that said, I’m still surprised that the PSA failed to pass. The agreement was despicable in objective terms, but still managed to provide stability and predictability in its sadism. Rejecting the agreement once again puts Ontario’s doctors at the mercy of the Liberal Government, a government that has shown its willingness to engage in unilateral action, even at the expense of Ontario’s doctors, tax payers and patients. The Liberal Government will likely impose an even harsher version of the rejected PSA and pass bill 210 (the ironically named “Patients First Act”) unamended. Bill 210 is punitive in nature and cripples the ability of health practitioners to manage their own practice while grossly expanding the scope of powers of the Minister of Health.

After comparing these two options, voting “for” this agreement seems maddeningly reasonable. The Ontario Government assumed that physicians would vote in alignment with their self interests and begrudgingly vote in favor of the devil they knew. What Ontario’s doctors gained by voting against the PSA is not something that is tangible. Rejecting the PSA was our profession’s confessional – it was our moral absolution. We will not be complicit in the erosion of our health care system. We are its champions and we will stand and defend it.

The word “advocacy” gets thrown around a lot in medicine and is a concept that those within the profession are perhaps overly familiar with. “Advocate” is one of the six cardinal roles that the Canadian Medical Association (CMA) identifies for physicians and “advocacy” is a deeply ingrained tradition of medicine. Physicians strive to advocate for their patients whether it’s by raising awareness for mental health, providing refugees with medical care, helping patients get access to the medications they need or just providing Ontarians with humanity and excellence in medical care. Rejecting the PSA is advocacy on a system level.

The rejection of the PSA marks a philosophical stand against the dismantling of health care that comes at great personal and professional cost. The Ontario Government likely crafted this agreement so that they could obtain the coerced consent of the medical profession and use it to legitimize further and continued cuts to health care. The language of the agreement would have made physicians responsible for increases in health care utilization, which some have compared to making firefighters financially liable for the number of fires they have to put out. This would have given the government political ammunition to blame inevitable future increases in health care expenditure on physicians. Signing the PSA would have made further advocacy considerably more difficult. It would have transformed would be advocates into hypocrites. This was an agreement that in its essence demanded silence in exchange for a slight reduction in the immediate rate of health care cuts. The Liberal Government tried to manufacture consent and it failed.

I hope that the freedom to continue to meaningfully advocate against harmful pieces of legislation is worth the heavy price that was paid. The medical profession is in an extremely precarious position and will no doubt face some trying times ahead. I hope that our rejection of the PSA is proof that we cannot be broken and that we will continue to advocate even in the face of continued propaganda and retaliatory measures. Ontario’s doctors must serve as a check against the Ontario Liberal Government and their apparently willful destruction of our health care system.

There will come a time when we look back and reflect on the events that led to the creation of our modern health care system. In 1946, Tommy Douglas introduced the Saskatchewan Hospitalization Act, which became the model for health care across Canada. In 1984, the Canada Health Act introduced universal health care across the nation. In 1991, the OMA agreed to become a closed shop organization with mandatory membership. In 2016, the OMA rejected the Province’s Physician Services Agreement. August 14, 2016 was a day of significance.